town of orangetown resume of operations and equipment · 2019. 3. 19. · resume of operations and...

If the facility has existing and applicable local, county, state or federal permits, licenses or

certifications, copies of such are to be listed below and included in this application.

PROJECT NAME:

Town of Orangetown

Resume of Operations and Equipment

Application InstructionsThis application is to define equipment and operations for a new or existing facility or process to

determine applicability to Town of Orangetown Performance Standards. The information herein is

required for the Town Zoning Board to make such determination regarding the Applicant's

proposed use of the land.

Do not start work before obtaining necessary permits to avoid subjecting the Applicant and

contractors engaged in The Project to enforcement action, which could include: 1) civil or criminal

court action, or both; 2) fines; 3) an order to remove structures or materials or perform other

remedial action; or 4) both a fine and an order.

This PDF document is based on Microsoft's Excel format converted to PDF. Data can be entered directly into

the areas designated, or the application may be printed and filled in by hand. To fill in electronically, open

this document in Adobe Acrobat, click on "Typewriter" under "Tools", and begin typing. Font size is

restricted. Additional pages can be included in the application.

e.g., air, water, waste, etc.

The Applicant must provide information and background showing the derivation of

anticipated air emissions, water discharges and waste disposal, appropriate to the

Projects' applicability to Town Performance Standards.

Submitted

Paper Copy?

Y or NURL or Website Information

AgencyType of Permitlocal, county,

state, federal

1 Version 3, 1/30/2019

Town of Orangetown


Type of Action/Application: Place an "X" to the left of the appropriate categories.

New Significant Modification Other:

Renewal Administrative AmendmentMinor Action Major Action

Ownership: Corporation

Place "X" to left

of box Partnership

Owner Name:

Street:

Business EIN:

City/Town:

State/Province:

ZIP:

State/Province:

Owner/Firm/Facility Contact

Name: Phone:

This Application is required for the Town to make a determination regarding the applicant's proposed use of the

land and buildings. Attach Additional Sheets as Needed.

PROJECT NAME:

I certify under penalty of law that I have personally examined and am familiar with the information

submitted herein in this application, and information in support of it , and that based on my inquiry of

those individuals responsible for obtaining the information, I believe that the submitted information is

true, accurate and complete.

Title:

Date:

Responsible Official: Print

Signature:

Facility / Owner Information

Facililty Name:

Facility Address:

Certification and Identification Information

Phone: Email:

Title:

Email:

Individual

Street Address:

City/Town:

Fax:

ZIP:

Country:

Other:

Affiliation:

2

Town of Orangetown


BUILDING & PROPERTY

Property Footprint, total sq. ft./acres Parking sq. ft.

Footprint, Largest structure, sq. ft.

Highest 'Story' on Site Full Time Employees

Part Time Employees

STATE ENVIRONMENTAL QUALITY REVIEW

http://www.dec.ny.gov/docs/permits_ej_operations_pdf/seafpartone.pdf

OPERATIONSNAICS:

1.

2.

3.

SIC:

1.

2.

3.

No. Shifts per Day

Hours per Day Operating

Principal Products of Manufacture/Assembly/Business

PROJECT NAME:

Total No. Structures

5.

This application requires completing and submitting to the Town only, the New York State

Department of Environmental Conservation's Short Environmental Assessment Form, Appendix B to

6NYCRR 617.20. Some of this information may be duplicated herein. This form can be accessed at:

Primary Line(s) of Business:

1.

2.

3.

Week Days Operating

3.

4.

The applicant must provide floor plans showing location of equipment, work stations, vents,

exhausts, chimneys or stacks, and associated industrial processes.

1.

2.

No. Parking Spots

3

Town of Orangetown


NOISE

Decibel

Correction

Daytime operation only Plus 5Plus 5

Plus 10

Plus 15

Minus 5

Noise of periodic character (hum, screech, etc.) Minus 5

During

Time of

Busiest

Activity

During

Time of

Slowest

Activity

Duration,

denote hours

or minutes

VIBRATION

PROJECT NAME:

Frequency per day

or Specific Time

Ranges

'Loudest' Producers of NoiseInclude construction and process operations.

Noise Level/Range Anticipated Outdoor:

Noise source operates less than 20% of any one hour period

Noise source operates less than 1% of any one-hour period

Noise source operates less than 5% of any one-hour period

Noise of impulsive character (hammering, etc.)

Use dB categories in Table Afollowing page

Type of Operation of Character of Noise

Based on descriptive decibel levels of Table A (following page), decibel corrections shown below

as appropriate, and in accordance with the Town's Noise Performance Standard 4.181, evaluate

the noise level for the processes you list below.

When appropriate, "frequency band cycles' as described in the Town's Noise Performance

Standard will be evaluated by the facility in the event of non-compliance with levels proposed

for this project. The Town may request this evaluation during the application process if more

complex noise patterns are expected.

It is understood that the applicant is familiar with, and anticipates compliance with, the Town's Vibration

Performance Standard, 4.171, during project construction and ultimate project operations. Any

anticipated aberrations from this expectation should be detailed below.

1.

2.

3.

4.

5.

4

Town of Orangetown


TABLE A

Decibel Levels

0 healthy hearing threshold 110rock band; jackhammer, jet flyover

@ 1000 ft.

10 a pin dropping 115 emergency vehicle siren; riveter

20rustling leaves; quiet rural area,

nighttime120 thunderclap; oxygen torch

30whisper, faint; quiet suburban area,

nightime125 balloon popping

40

babbling brook,

bird calls; quiet urban area,nighttime;

computer

130 peak stadium crowd

50

light traffic; quiet urban area, daytime;

refrigerator;

residential air conditioner @ 50'

135 air raid siren, near jet engine

60conversational speech @ 3'; air

conditioner; heavy trafiic @ 300'140 jet engine at takeoff

70 shower: living room music: dishwasher 145 firecracker

75toilet flushing; vacuum cleaner; gas

lawnmower @ 100', commercial area150 fighter jet launch

80alarm clock; garbage disposal; noisy

urban area, daytime155 cap gun

85 passing diesel truck; snow blower 160 shotgun

90

squeeze toy; lawn mower, food

blender, motorcycle @ 25'; arc welder;

diesel truck @ 50' @ 50 mph.

165 .357 magnum revolver

95inside subway car; food processor; belt

sander170 safety airbag

100motorcycle (riding); loud auto horn @

10'; lawn mower @ 3'; handheld drill175 howitzer cannon

105 sporting event; table saw 180 rocket launch

194 sound waves become shock waves

30 faint 90 very loud

50 moderate 120 deafening

70 loud 130 threshold of pain

Most noise levels are given in dBA, which are decibels

adjusted to reflect the ear's response to different

frequencies of sound. Sudden, brief impulse sounds, like

many of those shown at 120 dB or greater, are often given

in dB (no adjustment).

5

Town of Orangetown

Resume of Operations Equipment

Permits and Applicable Local, County, State & Federal Regulations

AIR*EPA New Source Performance Standards

NYSDEC:

Registration

Air State Facility Permit

Federal Title V Major Facility Permit

WASTE**Pesticide Control

Solid & Hazardous Waste

Radiation

Mineral Resources & Mined Land Reclamation

Noise from Heavy Motor Vehicles

RESOURCE MANAGEMENT***Land Use

Mineral Resources

Invasive Species

Real Property and Land Acquisitions

Water Regulaton

WATER****All other water applicable matters

GENERALState Environmental Quality Review

New York State Department of Health

Uniform Procedures per 6NYCRR 621.1

NYS Department of State

Additional

* http://www.dec.ny.gov/regs/2492.html

** http://www.dec.ny.gov/regs/2491.html

*** http://www.dec.ny.gov/regs/2490.html

**** http://www.dec.ny.gov/regs/2485.html

PROJECT NAME:

PRIMARY APPLICABLE REGULATIONS

Does the new or modified facility, process(es) or equipment require ANY additional permits, licenses, certifications or

other authorizations under local, county, state or federal jurisdiciton, or adherence to the regulations below? If so, list

the main applicable regulatory parts for each category.

For example, NYSDEC Air State Facility Permit: Part 201-5; industrial wastewater discharge, State Pollutant Discharge Elimination System (SPDES), Part

750; large gas burning engines, NSPS Subpart JJJJ.

Answers in the positive may cause the Town to only conditionally approve this project until these other requirments are

met. Additional information and specificity of regulations may be required. It is the applicant's responsibility to provide

proof of evidience of meeting all requirements.

6

Town of Orangetown


Combustion Sources

Combustion Source(engine, turbine, boiler, etc.)

No. of

Units

Equipment RatingList HP, KW, MMBtu/hr, CFM

with units

Processes

*

EPA Greenhouse Gas Reporting

EPA Toxic Release Inventory

National Emission Standards for Hazardous Air Pollutants

High Toxicity Air Contaminants per NYSDEC Part 212-2.2 Table 2

Emergency Planning and Community Right-to-Know Act (EPCRA)

Tier II NYS Emergency Response Commission

Solid Waste

Hazardous Waste

FHWA or NYSDOT

SPDES or NPDES* Mark with an 'X' those that are applicable.

Will any process, including combustion, use or storage, disposal, discharge,

emission, or release to the environment, be applicable and/or reportable to:

PROJECT NAME:

Fuels(e.g., natural gas, fuel oil, distillate or

residual oil, waste oil, wood)

7

Town of Orangetown


Chemical Characterization Codes Table B

Y or N

B explosive and blasting agents

C poison: gas,g; liquid,l; solid,s

D irritant

E flammable liquid

F flammable solid

H flammable gas: specify propane and/or butane

H-a flammables, NOS

I oxidizer

J organic peroxide

K combustible liquid

L radioactive material

M corrosive material

N "dangerous when wet" material

O etiological material

P combustible fibers

Does any operation consist of the following:

Q

R product poisonous fumes or gases

T spray operations

U fuel dispensing

V propane gas forklifts

W

If none of the above, identify substances as:

A aerosol

G gas

L liquid

S/P solid/powder

S/L slurry

Does any operation involve the use of any of the following:

produces dust subject to explosion or spontaneous combustion

any other operation which may present a fire, explosive,

radiological or other hazard

Use these codes to characterize chemicals and chemical products.

8

Town of Orangetown


Chemical Bulk Inventory

SINGLE, NON-MIXTURE CHEMICALSTop 5 by Amounts Used/Stored

CAS

Identification*

Table B

Characterization

CodeList all that apply

Yearly

Use/Stored(list gallons or pounds)

1.

2.

3.

4.

5.

# As would be expected to be found in agreement among bodies such as the National Academy of Sciences, the

U.S. Department of Health and Human Services' Agency for Toxic Substance and Disease Registry , the World

Health Organization's International Agency for Research on Cancer .

PROJECT NAME:

CAS Identification*

https://ofmpub.epa.gov/sor_internet/registry/substreg/searchandretrieve/substancesearch/search.do?search=

&substanceName=ethyl%20ketone&substanceNameScope=contains&substanceType=-1&hasComponents=both

1.

2.

3.

Carcinogen

Characteristic#

Yearly

Consumption (gallons or pounds)

Identify any on-site, single non-mixture chemical that is:

Known Human Carcinogen - KHC

Probable Human Carcinogen - PrHC

Possible Human Carcinogen - PHC

Other - Indicate

Is there any mixing on-site of any combination of single,

bulk substances and/or purchased mixtures? Indicate YES or NO

9

Town of Orangetown


Chemical Mixtures Inventory

PURCHASED CHEMICAL MIXTURESList Top Three By Amount Used or Stored,

and % of top three components of each

mixture, excluding water.

CAS

Identification*

& Percentage

Table B

Characterization

Code

List all that apply

Yearly

Used/Stored(include units: gallons,

g, or pounds, p)

M1.---

a.---

b.---

c. ---

M2.---

a.---

b.---

c. ---

M3.---

a.---

b.---

c. ---

Identify any on-site chemicals in any mixtures that are:

Know Human Carcinogen - KHCProbable Human Carcinogen - PrHCPossible Human Carcinogen - PHC

Other - Indicate

PROJECT NAME:

Yearly

Used/Stored, gallons or pounds

1.

2.

3.

Carcinogen

Characteristic

10

Town of Orangetown


Chemical Discharges

List raw material, or products, that emit to the

atmosphere or discharge to land or water.

1.

2.

3.

4.

5.

6.

7.

1.

2.

3.

4.

5.

6.

7.

PROJECT NAME:

Does this material - or products they form - emit or discharge

to a pollution control device? If so, list device(s).

SINGLE, NON-MIXTURE CHEMICALS

CHEMICAL MIXTURES

11

Town of Orangetown


Primary Process Descriptions

Describe Primary Processes:

PP1

PP2

PP3

PP4

PP5

PP6

PP7

PP8

PP9

PP10

PROJECT NAME:

List all that apply

Characterization Codes from

Table B

Provide a facility blueprint, drawing or schematic showing

locations of the processes described below.

12

Town Of Orangetown


Control Systems

C1

C2

C3

C4

C5

C6

C7

C8

C9

C10

PROJECT NAME:

Describe control methods such as pollution and odor controls, fire alarm

systems, automatic fire suppression devices such as sprinklers, portable fire

extinguishers, and any other safety devices.

13

Town of Orangetown


DEFINITIONS

Refer to:

Refer to:

RESERVED

Responsible official. A president, vice president, secretary, treasurer, general partner,

proprietor, principal executive officer, ranking elected official, or any other person who performs

policy or decision making functions and is authorized to legally bind a corporation, partnership, sole

proprietorship, or government entity which operates a facility that is subject to the provisions of this

Application. Whenever the term responsible official is used in this document or in any other Town

regulations, it shall be deemed to refer to the “designated representative” with regard to all matters

under this application.

https://govt.westlaw.com/nycrr/Document/I4ec46aa7cd1711dda432a117e6e0f345?viewT

ype=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&conte

xtData=(sc.Default)

Minor Project - Projects as described under NYSDEC's Uniform Procedures, 6 CRR-NY 621.4

Major action/project - actions for which permit applications are to be sent to the NYSDEC under

6NYCRR621.1.

https://govt.westlaw.com/nycrr/Document/I4ec443aacd1711dda432a117e6e0f345?viewT

ype=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&conte

xtData=(sc.Default)

Modification means any change or amendment whatsoever to a permit that is currently in force,

including permit transfer.

Research and Development activities. The primary purpose of such activities is to conduct

research and development into processes and products, where such activities are conducted under

the close supervision of technically trained personnel. Research and development activities do not

include activities whose primary purpose is to produce commercial quantities of materials.

14

Town of Orangetown


Additional Information or Explanantions

PROJECT NAME:

15

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